The purpose of this study was to assess the prevalence and type of psychological distress in women with vulvar vestibulitis syndrome (VVS). A retrospective chart review was conducted of all women receiving a diagnosis of VVS referred to a tertiary care facility during a two-year period. Brief psychological questionnaires, including the Personality Assessment Screener, Fear of Negative Evaluation Scale, Golombok-Rust Inventory of Sexual Satisfaction, and the Phobia Rating Scale were administered. Fifty-consecutive cases were reviewed along with 12-15 month follow-up data for 41 cases. Phobic anxiety to vaginal touch or entry was significantly higher in women with VVS than normative data. Fear of Negative Evaluation was a strong associated feature, and for 30% approached clinically significant levels. Twenty-six percent showed a moderate, while another 26% showed a mild clinically distressed profile. Negative affect and social withdrawal were among the most frequently endorsed variables. Improvement in allodynia and intercourse were both related to these psychological variables, and a multiple regression analysis supported the use of psychological instruments in addition to standard medical assessment. A subgroup of women with VVS display clinically significant broad based psychological distress that warrants additional assessment. The use of psychological questionnaires in addition to medical assessment of women with VVS may provide valuable information predictive of treatment needs and response.
Conflicting data exist regarding the sexual arousal patterns of post-operative male-to-female (MTF) women with Gender Identity Disorder. The purpose of this study was to examine objective and subjective aspects of the sexual arousal response using a vaginal photoplethysmograph. Fifteen MTF women viewed neutral and erotic audiovisual film segments while their blood flow patterns were monitored. Subjective measures of affect and sexual arousal were taken before and immediately after the films. There was a significant increase in self-reported subjective arousal, perceived genital arousal, perceived autonomic arousal, and positive affect; however, movement artefacts interfered with our assessment of the genital arousal response. MTF women reported both low levels of pain and low levels of awareness of the vaginal probe during testing. These data are discussed in the context of differences in pelvic musculature between natal and new women and have implications for future studies that aim to measure sexual arousal objectively in MTF women.Keywords: Gender identity disorder, male-to-female transsexual, sex reassignment surgery, vaginal photoplethysmography, sexual arousal Gender Identity Disorder (GID) is diagnosed when an individual experiences (1) a strong, persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex), and (2) a significant discomfort with his or her sex or a sense of inappropriateness in the gender role of that sex (termed gender dysphoria) [1]. GID should be distinguished from Transvestic Fetishisma form of cross-dressing that the DSM-IV-TR describes as often being associated with intense sexual fantasies or sexual urges. In a small number of individuals with transvestic fetishism, there is also the persistent desire to live and dress permanently as the opposite sex, in which case the diagnosis becomes Transvestic Fetishism with Gender Dysphoria.Views on GID have changed considerably over the last three decades, from attempting to ''treat'' individuals with the disorder through various behavioural therapies [2,3], to focusing on quality of life via surgical techniques that preserve sexual function [4,5]. The Harry Benjamin International Gender Dysphoria Association was established in 1978 to provide Standards of Care for health professionals treating individuals with GID. According to the Standards of Care published in 1998 [6], Sex Reassignment Surgery (SRS) is considered to be ''effective. . .when prescribed or recommended by qualified practitioners, is medically indicated, and [is] medically necessary''. Research on the long-term results of SRS in individuals with GID includes studies examining physical function [7], psychological function [8], and satisfaction with surgery [9]. For example, a large retrospective study on 232 male-to-female (MTF) women at least one year following SRS indicated that 96% were happy with the surgical results and 97% experienced improved quality of life as a result [5]. Moreover, no individuals rep...
This article will illustrate how marital therapists and their supervisors can instructively use the Basson Sexual Response Cycle (BSRC) as a teaching and therapeutic tool to enable students to move their clients toward improved sexual relationships. Second, it will illustrate that the Basson model can be integrated into Emotionally Focused Martial Therapy (EFT) to track and shift the couple's habitual attachment pattern or circular fight. Third, it will show that by working the triangle of emotion and the triangle of conflict described in the Brief Psychodynamic Model during the second step of stages 4-6 of EFT, the couple therapist has a working methodology to create change at a deeper emotional level, when the couple's intimacy issues are complex. Two case examples will be used.
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